October 27, 2013
That this is so, somehow strengthens my conviction that we just can't know what we need or want all that well - or if ever, very rarely. And I'm damned sure we can't know what the other needs or wants either.
Because - who knows? Maybe this 'other' just so happens to need or want me. Need and want me for reasons they'll never understand or be able to articulate. Ever.
And then it follows that it doesn't matter if I'm this way or that way. Whether the other person who could be in my life is this way or that way. Because to the other's needs or desires - well, I'm just what the doctor ordered.
Simple words, but they mean so much to me. Getting to know what I want or need has been so hard. That it is easy, is a lie our culture and our media perpetuates. And we lap it up. "Just figure out what you want. Find out what you need. And go for it. Fulfill your desires, fulfill your needs (and buy our products)".
And don't be fooled - I wrote "...has been so hard" just now. Don't think for a moment that I've reached an understanding of these fundamentals. Nope. A felt-sense, maybe. But only softly, softly - in the quietest of moments. And the deeper I go, the less concrete the answers become. The message that echoes for me, as I think about crucial moments of connecting or relating with others, is patchy at best. The signal and the words are garbled, and all that emerges, all that's heard is 'I want' or 'If only' or 'I want to them to hear me - to know me - to just accept me'.
'Me'. So simple, so fundamental.
And then I thought about this primal pulse, this drumbeat: "I want to be needed" and "I need to be wanted", softly softly, gaining and losing in volume as life washes by. Put two people together and perhaps there will be moments of harmonics. I mean, there ought to be, or so the odds go. Moments of sympathetic vibration - when my 'want to be needed', and my 'need to be wanted' begins to hum in synchrony with their 'want to be needed', their 'need to be wanted'.
And so when do we know when we love someone? When do we know when we matter to them, that they love us?
Know? That's a hard one. Maybe I know when my heart is quiet. Maybe it's when the waves aren't crashing over us. Maybe at those times when we're both lost in thought, or simply becalmed.
I think it's when I feel, and can hear myself somehow saying that "right now, at this very moment, at this very place, with this person - things are okay". But it's more than that. It has to be more than that. It can't be a few isolated moments. Relationships don't exist or develop in a few isolated moments. Relationships are built over a bedrock formed of a primordial time - older than we can ever know. They span our whole lives, even if we've only known one another for a month.
I remember this feeling - the isolated case of when everything was okay. I was with someone, and I felt that it was a moment without past or future - rooted there and then. I felt acutely that then and there, the world was okay. I knew that after that moment, things wouldn't be or feel okay but that this was acceptable because that's just how life goes. But that the feeling could return, given the right opportunity. Imagine being with someone where you experience this feeling over and over.
Maybe that's love. Nothing more, and nothing less. A sounding, a tattoo, a drumbeat - and when we listen carefully for a while, we both hear "right now, at this very moment, the world is okay".
August 24, 2013
Okay. I've had it. Time for a rant.
I have HAD IT with these 'scientist' mumbo-jumbo medical establishment fakers. HAD IT! I'M FED UP! A bunch of liars, reclining in their Big Pharma funded laboratories.
Listen: I don't believe in that thing they call diabetes. And nor should you. It's fake. Just a bunch of lazy-ass attention-seekers who don't try hard enough to appropriately regulate their blood glucose levels with the hormone insulin. Regulate it, you losers! Simply buckle down, spend a little energy getting your pancreas creating insulin a teensy-weensy more responsibly, stop pigging out on junk food with high carbohydrate levels and quit bitching so much.
Honestly. Like we don't all have the same problems... We all suffer from low blood sugar at times. Right? Does that mean we all have diabetes? NOOO! What makes them so special? "OH I'M SO SPECIAL WAH WAH WAH."
Know this - diabetes is a made-up disorder, perpetuated by Big Pharma, and the totalitarian drug-pushing medical establishment who ignore the wisdom of our elders - exercise, morals, strength of pancreas and character. Insulin enslaves our youth, and alters their personalities so that their brain has appropriately regulated levels of glucose and so that their organs and CNS are not adversely affected, causing everything from wound-healing problems to amputation, organ failure, and death.
But big deal. As if we all don't have those problems. Everyone feels a little tired. Who hasn't collapsed in a coma after a hard day of work? Again, all I hear is "WAH WAH WAH I'M A WITTLE TINY BABY AND MY PANCREAS CAN'T PRODUCE ENOUGH OF MY OWN INSULIN WAH WAH GIMME A COOKIE".
This sort of preferential treatment, and pandering to special interest groups gets me so hot under the collar. I could go on, but spread this message: diabetes is fake. Don't let some 'scientist' scam-artists rob our children and adults of ill-health and poor functioning by pushing drugs (edit: I meant 'rob our children and adults of *good-health and normal functioning*... ').
Here is a little known fact, based on my EXTENSIVE research of these evil drug companies. Did you know that some insulin is OBTAINED FROM PIGS? Pigs - who sit around in mud and who many religions forbid us from eating. Think about it. Is pig insulin EVER mentioned in any holy text, or ancient document? No? Well, the ancients knew something that many people don't know today: PIG INSULIN IS BAD. Plus, have you ever wondered why the big media are trying to expose our children to tv shows showing pigs? Programs like Olivia (about a friendly pig), or Sesame Street (which tries to make it out that pigs are fun, and are okay to play with Grover, Big Bird, Oscar the Grouch, and the rest of them). You guessed it! It's because Big (pig?) Pharma wants to sell you insulin.
And Big Pharma is owned by the same people who own Big Media (hence the Sesame Street connection).
And may I remind you that pigs lay about in mud, and that mud contains so many pathogenic organisms that I can't even begin to list them. Just another reminder, I suppose, of the degeneracy of this 'diabetes-generation' who refuse to eat properly, and play video games all day long.
I'm getting tired just thinking about all of this. You know?
You know, as I write this, I'm reminded of that fake ADHD thing, also.
C'mon. Who doesn't get a little distracted? Full of energy? Impulsive? Encumbered by executive function deficits? Now THERE'S a classic example of lazy fakers pretending that they have neurobiological differences in their brains' basal ganglia components – the caudate, putamen, and globus pallidus – which researchers say present statistically significant consistently diminished volumetric measurement results. They just sit around all day, acting entitled, distracted, holier-than-thou, and unable to establish effective executive function activity due - or so those 'scientists' (big pharna drones) say - in part, and related to decreased right caudate volumes, and reversed caudate asymmetry, i.e., not the typical right-left caudate relationship. In addition, apparently these biased bullcrap and horse puckey studies noted a decreased volume of the putamen, reversed putamen asymmetry, and decreased volume of the right globus pallidus.
Yeah. Sure. And AS IF consistent evidence for a genetic association to the ADHD phenotype (note that genetic researchers like to make things up and are obviously geeks don't know how to relate to real people with strong moral values like hard work, etc... ) has been shown for markers in the DA (that's dopamine to you and me, reminding me that the researchers are a bunch of dope-fiends, undoubtedly) receptor D4 (DRD4), DA receptor D5 (DRD5), DA transporter (SLC6A3/DAT1), serotonin receptor 1B (HTR1B), serotonin transporter (SLC6A4/5HTT), and synaptosomal-associated protein 25 (SNAP-25) genes.
"SNAP"? Couldn't they think up something a little more original? Fakers. I bet that they also think Neil Armstrong and Buzz Aldrin actually landed on the moon.
Blah, blah, blah. Be careful. They'll try to convince you that a variety of brain subregions including the frontal and parietal cortexes, basal ganglia, cerebellum, hippocampus, and corpus callosum were found to be affected in ADHD.
Diffuse striatal connection abnormalities? Horse-puckey! Did your grandparents ramble on about functional MRI studies in children and adolescents with ADHD showing decreased connectivity in fronto-striato-parieto-cerebellar networks? No! Because they had strength of character. They were REAL. Salt of the earth.
Did Churchill, or Patton babble on about this connectivity being shown to be normalized by methylphenidate except in the parieto-cerebrellar functional circuit? No. Because they had responsibilities and decency and character and forbearance and worked hard and didn't whine all day long like a bunch of babies. They just worked harder.
Imagine someone saying that imaging techniques have pointed at three areas closely related to the basal ganglia, believed to be responsible for the symptoms of ADHD, the prefrontal cortex (part of the frontal lobe), the caudate nucleus (part of the basal ganglia), and the globus pallidus (part of the basal ganglia). Well. There's just one, uh, TEENSY WEENSY problem. How do you take someone's brain, take an image of it, and put it back into their skulls afterwards WITHOUT ANY ILL EFFECTS? YOU CAN'T! THAT'S JUST IT! ALL THIS RESEARCH IS PREDICATED ON A LIE - that living brains can be removed for study without killing the patients. Right? Are you following me still?
Listen. I could go on with this rant, but I've got things to do. I'm in the midst of a house move and need to find my ADHD medication.
April 30, 2013
March 28, 2013
I got a comment just now from a reader which included questions about their medications. They take methylphenidate and Strattera and are wondering about the length for duration, or of the overall effectiveness of their medication.
As a non-professional, I responded as follows, and hope that it clarifies my own understanding of medication as it relates to ADHD treatment. I would be very interested to hear from readers their thoughts on my perspective, and the advice I gave...
I wrote (I have modified it slightly for clarification below):
"Have you spoken with your doctor or psychiatrist? Methylphenidate and the amphetamine class of psychostimulants work for some and don't work for others - it can't really be predicted, depends on the individual. There are dosage aspects, metabolism issues, concurrent medication useage, and a host of other factors involved, not to mention your own personal level of change or stress due to situational factors (New job, school, city? Change in relationship status? Problems in your personal life? Are you getting sufficient sleep?)
Strattera didn't really work for me by itself, and I no longer take it. But I do take another NSRI class medication - buproprion (trade name Wellbutrin). Some of the NSRI meds can be useful in reducing some of the anxiety which may be brought on by taking the stimulants and may assist executive function, or so I understand.
What form of methylphenidate are you taking? Long release like Concerta or Adderall XR, or short release, like short release Adderal or Ritalin?
A good psychiatrist with a clear understanding and training in psychopharmacology should help you tweak your medication. I would definitely speak with your doctor about this, though.
To get the most out of your appointment, I'd recommend the following:
Try to track your cognitive senses throughout a few days in a notepad - i.e. Your focus level between 1 and 10, attention.
Track your emotions also - and your reactivity, irritability, grumpiness, ability to manage transitions or to shift out of hyperfocusing without being too pissed off(!). Basically, your level of attention self-regulation.
Track impulsive behaviors - interrupting, acting out, moving on to an inappropriate task or activity, when you should be sticking with the one you're already on.
Also try to document your ability to get priority items done, your ability to be organized, your level of overall 'effective functioning' in various arenas of your life. That is, how well you are managing at work, home, school, parenting, relationships, hobbies, sports, personal care, etc...
Bring this tracking information to your doctor / psychiatrist and it should help them better understand how to help you find an effective medication regime. Hope that helps.
Note that I'm not a medical professional, so just take my advice as you see fit. All the best, and let me know how it works out!"
July 19, 2011
- Take time to meet with friends or a small group of adults. Don’t let yourself become isolated.
- Exercise regularly. Find a partner, if possible, so you won’t forget to do it!
- Find a quiet spot for yourself at home. Use it to relax, meditate & re-focus.
- Use “pattern planning” to organize your days. Plan the same activities for same time each week.
- Do not over-schedule your time. Learn time management skills & be realistic.
- Make a list of ideas & “to do” items to free your mind for concentrating.
- Review the items on your list, prioritize them, & cross of all you have accomplished.
- Close your door, if possible, when you don’t want to be disturbed.
- Build “flex time” into your schedule to allow for the unexpected.
- Set up a study area away from distractions & set specific homework times.
- Build in “break times” during long homework assignments. Use a timer.
- Do weekly bag dumping after your work or school week. Dig deep & get out all that old “stuff”.
- Devise a calendar of long-term assignments and projects to be carried in your notebook.
- Get daily exercise. Walk or bike. Exercise helps to keep you & your brain focused & energized.
- Learn how to be healthy. Eating good food helps to keep you focused, active & in a good mood.
- Make time for frequent review & tossing of old papers. Set small goals of a few papers each time.
- Mark what you read with a highlighter or flag important areas with small, colorful “post-it”s.
- Tackle time-consuming & detailed projects in stages. Develop a plan before you begin.
- Use your high productivity hour for your most important project & most difficult homework.
- Get educated about AD/HD. The more you learn, the more you can work WITH it & not against it.
- Keep a family calendar at home or online using a shared electronic calendar (e.g. Google Calendar).
- Design systems & guidelines for the family that is mindful of each person’s needs.
- Avoid morning chaos by getting everything “ready to go” for work & school the previous night.
- Become well educated on co-morbid / co-existing conditions.
- Plan regular friend & family outings. There are many activities that are low cost or free.
- Take a “team” approach to problem solving.
- Work together to get organized. Chunk down tasks into small steps for those with AD/HD.
- Set a scheduled family time every few months for tossing unused items, old clothes & old newspapers.
- Work toward a better understanding of friends & family members with AD/HD. There are gifts in each of us.
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July 2, 2011
I've been here and there getting things done, and I think I was kind of waiting to get attuned to a new job (a contract position), new medication, and a new daughter (she's 3 weeks old and now our 2 1/2 year old boy is a big brother...) before writing more about my progress and journey.
I'm here and in good spirits. In fact, the best I think I've ever been in.
The last three months have been great - in large part to the new medication I'm on. I returned to the clinic I'd initially had my diagnosis at, and saw a psychiatrist who was recently the president of the Ontario Psychiatric Association for a second opinion. He was terrific. So I went off Strattera, and as soon as it cleared from my system, started taking a drug called Vyvanse to manage my ADHD symptoms. For me, it was nothing short of incredible. I started at 20 mg, and have now moved up to 60 mg. I initially called it my James Bond 007 medicine. More on that later. In fact, Vyvanse works so well for me that I almost feel that I wasted nearly a year on Staterra.
Vyvanse is essentially an extended release formulation of Adderall and was approved only in January of this year in Canada. It has been around in the U.S. for much longer, and of course is essentially Adderall - a well-proven psychostimulant which has been around for decades. What's different is that some clever chemists attach a lysine (amino acid) molecule onto the dexamphetamine, and ended up with the delicious-sounding lisdexamfetamine dimesylate. This pharmaceutical processing makes Vyvanse a prodrug - a pharmacologically inactive compound that require in vivo (in your body) conversion to release therapeutically active medications.
The prodrug aspect of Vyvanse achieves a couple of goals:
The first is to prevent the abuse of the drug, because the only way you can metabolize it into the stimulant dexamphetamine is by first orally ingesting the medication (gulp) and thereby allowing the drug to pass through your small intestine into your blood stream. It is on the surface of your red blood cells - after it has been absorbed through the microvillae on your small intestine's wall - that the lysine is cleaved away from the dexamphetamine, thus making it 'bioavailable'. So this precludes someone snorting the pill, or injecting it into their arm to get a quick rush. But from what I understand, even if you took a lot of the pills, their is still somewhat of what I call a metabolic turnstile, such that your body can only metabolize a certain amount of the prodrug at a certain maximum rate - so you wouldn't get an abuse-worthy amount of meds in your system if you tried.
The second goal is related to my last point, in a way. The medicine is metabolized at a given fixed rate - based on your system's 'throughput' rate and in this case, the psychostimulant is released in your bloodstream body over a period of up to 14 hours. This sustained, smooth release allows for full coverage throughout your waking day into the early evening - and doesn't give you a crash at the end.
And so I return to the James Bond 007 reference from earlier. The first week I was taking Vyvanse, I noticed clear and positive cognitive effects, and virtually no physical side-effects (other than some minor dryness of my mouth, which passed after a few days). I could focus appropriately and without effort. No longer did I unintentionally scoot from thought to thought, activity to activity, daydream to daydream and from topic to topic during a conversation. I stayed on track. I felt as though my situational awareness was heightened - yet controllably so. You can imagine a scene in a James Bond movie, or in a movie like the Bourne Ultimatum where the secret agent is in the middle of a mission requiring his full attention. This attention comes from a combination of extensive training, rehearsal, knowledge, physical fitness, mental acuity and a strong sense of confidence. Thus James Bond walks with sureness, certainty, does not get sidetracked, and goes about his dashing, albeit lethal business. Although in my case, the business does not involve blowing up embassies, shooting bad guys and rescuing wailing dames from the grips of deranged sociopathic baddies. Generally speaking.
Within a few weeks I stopped being so aware of my increased focus - which makes sense. I think I just got used to this improvement. But cognitive effects aside, the way I know that Vyvnase is really working for me is with my external environment, i.e. the world around me, the things on which I have agency and the world in which I take action.
My personal Action List, comprising all the large and all the minor things I need to complete in every arena of my life, which I have been diligent in gathering and maintaining over the past year, has decreased in length. Now it isn't often that a decrease in length is considered a significant selling point for a medicine (ba-dum-CHING!), but I have been able to tackle the really big projects on my list and been able to remove a lot of items from my list. I am acutely, almost painfully aware that I have a life-time of deficit to catch up on, and so I've been running at full steam to get things done - propelled both by excitement and happiness and indeed by a newly found focus. I can see the list diminishing, and with each item crossed off, I get a little bit stronger and gain a little bit more pride in myself. I suppose you could say my self-esteem is improving.
And as a result of going on Vyvanse, I've had a few insights. One of them is that I've learned a large part of my difficulty with getting projects done was a combination of 1) my poor (neurobiologically influenced) pre-conscious attention modulation resulting in me rapidly turning away (without being aware of this) from thoughts of daunting, uninteresting complicated or mundane tasks, and 2) a life-long paucity of experience and learned competency with organization, planning, and coping skills. That is, 'was never good at it, so never learned it, and so now has to learn it'). And between my deficient and neurobiologically impaired attentional capacities, and my deficient executive-functioning skills lies a set of deeply engrained core schema beliefs about my ability to sustain and achieve real change and to attain a competent sense of agency & control over my environment, personal & work life, and relationships with others.
Another insight is that it would have been really (REALLY) nice if I'd been identified as having significant attentional problems when I was a child. Scanning through my grade 4 report card, I read the following note:
"He is is obviously a capable boy as his contributions at group time and comprehension reveal - oral, reading. He is also quite fluent. This ability is not reflected however in his written work which appears often hastily completed. At times he is disruptive to those around him and as well he's easily distracted. His projects cover a lot of material but lack organization. Record keeping was accurate but could have been presented in a neater fashion."
So I was a capable boy, engaged and interested in working in a group, and demonstrated good oral, verbal and reading abilities. I was seen as disruptive (i.e. impulsive). Easily distracted. Hastily finishing work due to poor organizational and time management skills. Demonstrated lower than normal executive functioning as seen in my poorly-organized written work (as compared to my otherwise notable conceptual abilities). Messy record keeping indicative of comorbid dysgraphia. I'm sorry - HOW did my parents, teachers, guidance counselors, and other involved professionals NOT see ADHD as a strong possibility, or at the very least, refer me for professional assessment? Forget most of the items - let's assume all of the adults were half-asleep, hungover, or preoccupied with much more important things. What about the 'disruptive and distractible' parts? C'mon, folks. This wasn't the 1950s. This was the late 1970s and 1980s where guidance counselors were lining up, salivating at the opportunity to deal with my confounding combination of high potential, high intelligence, ravishing good looks and very low performance. And NONE of them saw a pattern in the chaos.
I mentioned earlier that I feel that I'm catching up with a lifetime deficit of getting things done, resulting in a long list Action Items which I need to take care of. And in the same way, I'm catching up and dealing with a bunch of emotional baggage. As I get healthier, and stronger and begin to get more perspective on my life, I begin to feel quite sad for me: for that strained, hopeless, frustrated, 'lazy and helplessly stuck' kid, that teenager, that young adult who suffered so exquisitely with all of the symptoms and the consequences of severe ADHD, combined subtype. And with that comes anger, and some wondering of how I managed to slip through the cracks. And yet at the same time, I recognize these feelings are natural - and that probably every adult who is late-diagnosed with ADHD goes through the same motions and emotions. And I hope to cover off more of this in future posts.
Switching gears somewhat, I have to make clear that while Vyvanse is working for me, it is truly 'to each their own' when it comes to medication. Physicians can use a variety of medications to treat and address the neurobiological / cognitive symptoms of adult ADHD. Each individual reacts differently to the various medications, depending on their metabolism, the expression of their genes, existing psychiatric comorbidties (anxiety, mood disorders etc...), confounding non-psychiatric conditions, other medications they are on, the ADHD subtype ('maybe' - this is something I came across recently), and the medication treatment regime and circumstances (titration rate, dose - not too little, not too much) - and effective, appropriate medical follow-up. And I'm sure there are several more factors I'm missing. The long and short of it is that medication works for ADHD, but you and your physician have to figure out the right medication through an empirical, educated, and trial-and-error approach.
And while the psychostimulants can work quickly - and result in remarkable changes in a person's life - the other pieces of the treatment arsenal have be brought to bear. The most effective treatment is a combination of medication, psychoeducation (i.e. learning about the disorder and the various techniques, coping strategies and skills that can provide relief) and psychosocial interventions including individual, group, or family counseling and ADHD skills coaching.
Those other pieces of the treatment arsenal will have to wait for future posts, though. It is late, and I am tired.
Hope you're all doing well. I'm glad to be back.
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